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Introduction: adolescence is a critical stage of rapid biological, emotional and social change and development. Adolescents and young adults (AYA) with asthma and allergies need to develop the knowledge and skills to self-manage their health independently. Healthcare professionals (HCP), parents and their wider network play an essential role in supporting AYA in this process. Previous work showed significant limitations in transition care across Europe. In 2020, the first evidence-based guideline on effective transition for AYA with asthma and allergies was published by EAACI.Aim: we herein summarize practical resources to support this guideline's implementation in clinical practice.Methods: for this purpose, multi-stakeholder Task Force members searched for resources in peer review journals and grey literature. These resources were included if relevant and of good quality and were pragmatically rated for their evidence-basis and user friendliness.Results: resources identified covered a range of topics and targeted healthcare professionals, AYA, parents/carers, schools, workplace and wider community. Most resources were in English, web-based and had limited evidence-basis.Conclusions: this position paper provides a valuable selection of practical resources for all stakeholders to support effective transitional care for AYA with asthma and allergies. Future research should focus on developing validated, patient-centred tools to further assist evidence-based transition care.

Regional and national legislation mandates the disclosure of “priority” allergens when present as an ingredient in foods, but this does not extend to the unintended presence of allergens due to shared production facilities. This has resulted in a proliferation of precautionary allergen (“may contain”) labels (PAL) that are frequently ignored by food-allergic consumers. Attempts have been made to improve allergen risk management to better inform the use of PAL, but a lack of consensus has led to variety of regulatory approaches and nonuniformity in the use of PAL by food businesses. One potential solution would be to establish internationally agreed “reference doses,” below which no PAL would be needed. However, if reference doses are to be used to inform the need for PAL, then it is essential to characterize the hazard associated with these low-level exposures. For peanut, there are now published data relating to over 3000 double-blind, placebo-controlled challenges in allergic individuals, but a similar level of evidence is lacking for other priority allergens. We present the results of a rapid evidence assessment and meta-analysis for the risk of anaphylaxis to a low-level allergen exposure for priority allergens. On the basis of this analysis, we propose that peanut can and should be considered an exemplar allergen for the hazard characterization at a low-level allergen exposure. Resumen: La legislación regional y nacional exige la divulgación de alérgenos "prioritarios" cuando están presentes como ingrediente en los alimentos, pero esto no se extiende a la presencia involuntaria de alérgenos debido a instalaciones de producción compartidas. Esto ha dado lugar a una proliferación de etiquetas de precaución para alérgenos ("pueden contener") (PAL) que los consumidores alérgicos a los alimentos suelen ignorar. Se han hecho intentos para mejorar la gestión del riesgo de alérgenos para informar mejor el uso de PAL, pero la falta de consenso ha llevado a una variedad de enfoques regulatorios y a la falta de uniformidad en el uso de PAL por parte de las empresas alimentarias. Una posible solución sería establecer “dosis de referencia” acordadas internacionalmente, por debajo de las cuales no se necesitaría PAL. Sin embargo, si se van a utilizar dosis de referencia para informar la necesidad de PAL, entonces es esencial caracterizar el peligro asociado con estas exposiciones de bajo nivel. Para el maní, ahora hay datos publicados relacionados con más de 3000 desafíos doble ciego controlados por placebo en individuos alérgicos, pero falta un nivel similar de evidencia para otros alérgenos prioritarios. Presentamos los resultados de una evaluación rápida de la evidencia y un metanálisis del riesgo deanafilaxia a una exposición a alérgenos de bajo nivel para alérgenos prioritarios. Sobre la base de este análisis, proponemos que el cacahuete puede y debe considerarse un alérgeno ejemplar para la caracterización del peligro en una exposición a un alérgeno de bajo nivel. Instituto de Investigación de Tecnología de Alimentos Fil: Turner, Paul J. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Patel, Nandinee. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Ballmer-Weber, Barbara K. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Ballmer-Weber, Barbara K. Clínica de Dermatología y Alergología. Kantonsspital; Suiza. Fil: Baumert, Joe L. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Blom, W. Marty. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Brooke-Taylor, Simon. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Brough, Helen. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Brough, Helen. King's College London. Departamento de Alergia Pediátrica; Reino Unido. Fil: Campbell, Dianne E. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Campbell, Dianne E. Tecnologías DBV. Montrouge; Francia. Fil: Chen, Hongbing. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Chinthrajah, R. Sharon. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Crevel, René W.R. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Dubois, Anthony E.J. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Ebisawa, Motohiro. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Elizur, Arnon. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Elizur, Arnon. Universidad de Tel Aviv. Facultad de Medicina Sackler. Departamento de Pediatría; Israel. Fil: Gerdts, Jennifer D. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Gowland, M. Hazel. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Houben, Geert F. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Hourihane, Jonathan O.B. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Knulst, André C. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: La Vieille, Sébastien. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: López, María Cristina. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Mills, E.N. Clare. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Polenta, Gustavo Alberto. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Investigación Tecnología de Alimentos; Argentina. Fil: Polenta, Gustavo Alberto. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Purington, Natasha. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Said, María. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Sampson, Hugh A. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Sampson, Hugh A. Escuela de Medicina Icahn. División de Alergia e Inmunología Pediátricasen. Nueva York. Estados Unidos de América. Fil: Schnadt, Sabine. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Södergren, Eva. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Södergren, Eva. ThermoFisher Scientific; Suecia. Fil: Taylor, Stephen L. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Remington, Benjamin C. Imperial College London. Instituto Nacional del Corazón y los Pulmones; Reino Unido. Fil: Remington, Benjamin C. Grupo BV. Consultoría Remington; Holanda.

Introduction\ud \ud Food hypersensitivity (FHS), including food allergy, coeliac disease and food intolerance, is a major public health issue. The Food Standards Agency (FSA), an independent UK Government department working to protect public health and consumers’ wider interests in food, sought to identify research priorities in the area of FHS.\ud \ud \ud \ud Methods\ud \ud A priority setting exercise was undertaken, using a methodology adapted from the James Lind Alliance—the first such exercise with respect to food hypersensitivity. A UK-wide public consultation was held to identify unanswered research questions. After excluding diagnostics, desensitization treatment and other questions which were out of scope for FSA or where FSA was already commissioning research, 15 indicative questions were identified and prioritized by a range of stakeholders, representing food businesses, patient groups, health care and academia, local authorities and the FSA.\ud \ud \ud \ud Results\ud \ud 295 responses were received during the public consultation, which were categorized into 70 sub-questions and used to define 15 key evidence uncertainties (‘indicative questions’) for prioritization. Using the JLA prioritization framework, this resulted in 10 priority uncertainties in evidence, from which 16 research questions were developed. These could be summarized under the following 5 themes: communication of allergens both within the food supply chain and then to the end consumer (ensuring trust in allergen communication); the impact of socio-economic factors on consumers with FHS; drivers of severe reactions; mechanism(s) underlying loss of tolerance in FHS; and the risks posed by novel allergens/processing.\ud \ud \ud \ud Discussion\ud \ud In this first research prioritization exercise for food allergy and FHS, key priorities identified to protect the food-allergic public were strategies to help allergic consumers to make confident food choices, prevention of FHS and increasing understanding of socio-economic impacts. Diagnosis and treatment of FHS was not considered in this prioritization.

Background The European Academy of Allergy and Clinical Immunology has developed a guideline to provide evidence-based recommendations for healthcare professionals to support the transitional care of adolescents and young adults (AYA) with allergy and/or asthma. The goal of this work was to ensure that the draft recommendations are also important for patients. Methods We surveyed patients aged 11-25 years with allergy and/or asthma and their parents across Europe between 17th February and 16th March 2020. The multilingual survey was distributed through national allergy and asthma patient organisations in Europe as well as through social media. Results A total of 1210 responses from 24 European countries were collected. There were 415 (34.3%) AYA and 795 (65.7%) parents. The majority of AYA (72.3%) and parents (81.9%) were female. Patients had a history of asthma (61.1%), allergic rhinoconjunctivitis (54.1%), food allergy (53.8%), atopic eczema (42.6%), and anaphylaxis (28.8%). All recommendations achieved the median score of either 'important' or 'very important'. The least supported recommendations were the use of joint clinics with both paediatric and adult physicians attending and the use of web-based or mobile technologies for communication with the AYA. The most supported recommendation was checking that the AYA is knowledgeable and compliant with their prescribed medication. Qualitative analysis revealed conditional approval for some recommendations. Conclusions There was agreement from patients and parents on the importance of the draft recommendations on transitional care for adolescents and young adults with allergy and/or asthma and their parents. The recommendations now need to be implemented into clinical practice across Europe.

Objective To describe time trends for hospital admissions due to food anaphylaxis in the United Kingdom over the past 20 years. Design Analysis of national data, 1998-2018. Setting Data relating to hospital admissions for anaphylaxis and deaths, and prescription data for adrenaline autoinjector devices. Participants UK population as a whole and devolved nations (England, Scotland, Wales, and Northern Ireland). Main outcome measures Time trends, age, and sex distributions for hospital admissions for anaphylaxis due to food and non-food triggers, and how these admission rates compare with the case fatality rate (number of fatalities as a proportion of hospital admissions). Results Between 1998 and 2018, 101 891 people were admitted to hospital for anaphylaxis. Of these admissions, 30 700 (30.1%) were coded as due to a food trigger. Food anaphylaxis admissions increased from 1.23 to 4.04 per 100 000 population per year (from 1998 to 2018), an annual increase of 5.7% (95% confidence interval 5.5% to 5.9%, P Conclusions Hospital admissions for food induced anaphylaxis have increased from 1998 to 2018, however the case fatality rate has decreased. In school aged children, cow’s milk is now the most common single cause of fatal anaphylaxis.

Background: Adolescence represents a vulnerable time for individuals with asthma and allergic conditions. They suffer an unexpected degree of morbidity. This systematic review aimed to understand the challenges faced by adolescents and young adults with these conditions. Methods: A systematic literature search was undertaken across eight databases. References were checked by two reviewers for inclusion. Study data were extracted, and their quality was assessed in duplicate. A narrative meta-synthesis was undertaken. Results: A total of 108 papers describing 106 studies were retrieved, most focused on asthma. Five themes were identified across studies: (a) Health-related quality of life—impairment was associated with poor disease control, psychosocial issues, adolescent-onset allergic disease and female sex; (b) Psychological factors—asthma and food allergy were associated with anxiety and depression, atopic dermatitis was associated with suicidal ideation, and that parental emotional support may be protective; (c) Adherence—suboptimal adherence was associated with older age, barriers to medication usage, poor symptom perception and failure to take responsibility, and positive factors were routines, simpler treatment regimes, better knowledge and perceptions about medications; (d) Self-management—facilitated by education, knowledge and a positive attitude; and (e) Supportive relationships—families could modify barriers to adherence and foster positive views about self-management, adolescents suggested that their peers should be more involved in supporting them, and adolescents also wished to have support from nonjudgemental healthcare professionals. Conclusions: We have some understanding of the challenges faced by adolescents with asthma, less so for other allergic conditions. This knowledge will be used to support guidelines for managing adolescents.

Adolescent and young adult (AYA) patients need additional support, while they experience the challenges associated with their age. They need specific training to learn the knowledge and skills required to confidently self-manage their allergies and/or asthma. Transitional care is a complex process, which should address the psychological, medical, educational and vocational needs of AYA in the developmentally appropriate way. The European Academy of Allergy and Clinical Immunology has developed a clinical practice guideline to provide evidence-based recommendations for healthcare professionals to support the transitional care of AYA with allergy and/or asthma. This guideline was developed by a multidisciplinary working panel of experts and patient representatives based on two recent systematic reviews. It sets out a series of general recommendations on operating a clinical service for AYA, which include the following: (a) starting transition early (11-13 years), (b) using a structured, multidisciplinary approach, (c) ensuring AYA fully understand their condition and have resources they can access, (d) active monitoring of adherence and (e) discussing any implications for further education and work. Specific allergy and asthma transition recommendations include (a) simplifying medication regimes and using reminders; (b) focusing on areas where AYA are not confident and involving peers in training AYA patients; (c) identifying and managing psychological and socio-economic issues impacting disease control and quality of life; (d) enrolling the family in assisting AYA to undertake self-management; and (e) encouraging AYA to let their friends know about their allergies and asthma. These recommendations may need to be adapted to fit into national healthcare systems.

Background: This systematic review aimed to review the literature on interventions for improving self-management and well-being in adolescents and young adults (11-25 years) with asthma and allergic conditions. Methods: A systematic literature search was undertaken across eight databases. References were checked by two reviewers for inclusion. Study data were extracted, and their quality was assessed in duplicate. A narrative synthesis was undertaken. Results: A total of 30 papers reporting data from 27 studies were included. Interventions types were psychological (k = 9); e-health (k = 8); educational (k = 4); peer-led (k = 5); breathing re-training (k = 1). All interventions were for asthma. Psychological interventions resulted in significant improvements in the intervention group compared with the control group for self-esteem, quality of life, self-efficacy, coping strategies, mood and asthma symptoms. E-Health interventions reported significant improvements for inhaler technique, adherence and quality of life. General educational interventions demonstrated significantly improved quality of life, management of asthma symptoms, controller medication use, increased use of a written management plan and reduction in symptoms. The peer-led interventions included the Triple A (Adolescent Asthma Action) programme and a peer-led camp based on the Power Breathing Programme. Improvements were found for self-efficacy, school absenteeism and quality of life. Conclusion: Although significant improvements were seen for all intervention types, many were small feasibility or pilot studies, few studies reported effect sizes and no studies for allergic conditions other than asthma met the inclusion criteria. Research using large longitudinal interventional designs across the range of allergic conditions is required to strengthen the evidence base.

The U.K. food and grocery market is highly significant financially and dominated by 10 retailers within a regulated and extremely economically competitive environment. We summarize the approach of U.K. retailers to allergen risk assessment (RA) and risk management (RM) within the U.K. legal framework and explore public visibility of retailers’ allergen policies. RA and RM of allergens appear effective in curtailing retail-triggered severe food allergy reactions. However, allergen recalls remain high, precautionary allergen labeling (PAL) remains an area of confusion, and there is no consistent Web-based provision of information for consumers who have allergies. Resolution of PAL awaits an agreed-on threshold framework, but a key challenge is to engage with patients and gain their trust rather than thrust education at them. It would be helpful for retailers to publish their allergen RA and RM policies. A target should be agreed on between government and retailers for a reduction in the proliferation of PAL wording variants by a given date within the next 3 years. A further hurdle is potentially flawed allergen analysis—development of reference methods and reference materials are acknowledged needs. Laboratories should report allergen results in an informative manner, communicating uncertainty and caveats. Ideally a laboratory representative would be included on any incident control team. Efforts must continue to standardize preparedness for protecting and defending food and drink from deliberate attack.

Food allergy has a forensic context. The authors describe eight cases in the UK courts involving fatalities, personal injury or criminal non-compliance with food law from mainly 'grey' literature sources. The potentially severe consequences for people with food allergy of contraventions of labelling law have led to enforcement action up to criminal prosecution for what might otherwise be regarded as 'trivial' non-compliance. The authors suggest there should be central collation of such cases. Non-compliances should be followed up in a more rapid and robust manner. Evidence of fraud in the catering supply chain supports recent calls for zero tolerance of food fraud. Businesses must guard against gaps in allergen management, for which there are readily available sources of training and guidance, but also against fraudulent substitution in the supply chain, about which training and guidance should be developed. New allergen labelling legislation and case law appear to place responsibility on food businesses even for the forensically problematic area of allergen cross-contamination. The courts can be an effective last resort for vulnerable consumers; however, there is evidence of knowledge and skill gaps in both the investigation and prosecution of potentially serious incidents of food allergen mismanagement and mislabelling. Thorough investigation of food allergy deaths is required with a tenacious and skilled approach, including early realisation that samples of the food and/or stomach contents from a post mortem examination should be retained and analysed. The supply chain must be rigorously examined to find out where adulteration or contamination with the fatal allergen occurred.

BackgroundAvoiding food allergens when eating outside the home presents particular difficulties for food allergic (FA) and intolerant (FI) consumers and a lack of allergen information in restaurants and takeaways causes unnecessary restrictions. Across Europe, legislation effective from December 2014, aims to improve allergen information by requiring providers of non-prepacked foods to supply information related to allergen content within their foods.MethodsUsing in-depth interviews with 60 FA/FI adults and 15 parents/carers of FA/FI children, we aimed to identify FA/FI consumers’ preferences for written and/or verbal allergen information when eating out or ordering takeaway food.ResultsA complex and dynamic set of preferences and practices for written and verbal allergen information was identified. Overwhelmingly, written information was favoured in the first instance, but credible personal/verbal communication was highly valued and essential to a good eating out experience. Adequate written information facilitated implicit trust in subsequent verbal information. Where written information was limited, FA/FIs depended on social cues to assess the reliability of verbal information resources, and defaulted to tried and tested allergen avoidance strategies when these were deemed unreliable.ConclusionUnderstanding the subtle negotiations and difficulties encountered by FA/FIs when eating out can serve as a guide for legislators and food providers; by encouraging provision of clear written and verbal allergen information, and training of proactive, allergen-aware staff. This, in tandem with legal requirements for allergen information provision, paves the way for FA/FIs to feel more confident in eating out choices; and to experience improved eating out experiences.

For individuals with a nut allergy, the avoidance of allergens is particularly challenging in situations where they are not preparing their own food. Many allergic reactions occur when eating outside the home.

The skills and knowledge required to carry out food allergen avoidance are becoming increasingly sophisticated. It is not enough to know the names of a handful of dishes which contain a known allergen as an ingredient. Many lifestyles now depend on food prepared away from the home. New product development has introduced a wide range of ingredients and dishes which are labour saving, exciting and innovative. Product traceability now depends on advanced technological support as it struggles to keep up with foods manufactured, prepared and served in ever more complex circumstances. Consumers are now faced with ‘a jungle of choices’. However, those individuals who need to avoid a known allergen, particularly in trace quantities, often find that the food choice deemed suitable is poor, and the information available inadequate or even dangerously misleading. There are two important groups for whom this situation is a major concern. Thousands of families with young children are forced to live with the possibility that everyday foods may be contaminated by a known allergen which could kill in minutes. They live on their nerves, reading every packet and resorting to hyperprotective childcare and vigilance. In addition, the youngest independent consumers, teenagers and those in their twenties, may have little first-hand experience of food preparation. They may be ill-equipped in food-allergen risk assessment. Sadly, those who die from anaphylaxis or allergen-triggered asthma are often in this age-group. Current initiatives to support consumers at risk include a recognised standard for manufacturers seeking to eliminate an allergen from their production, and the integration of food allergy into training for caterers and food standards enforcement professionals.

Background The incidence of anaphylaxis might be increasing. Data for fatal anaphylaxis are limited because of the rarity of this outcome. Objective We sought to document trends in anaphylaxis admissions and fatalities by age, sex, and cause in England and Wales over a 20-year period. Methods We extracted data from national databases that record hospital admissions and fatalities caused by anaphylaxis in England and Wales (1992-2012) and crosschecked fatalities against a prospective fatal anaphylaxis registry. We examined time trends and age distribution for fatal anaphylaxis caused by food, drugs, and insect stings. Results Hospital admissions from all-cause anaphylaxis increased by 615% over the time period studied, but annual fatality rates remained stable at 0.047 cases (95% CI, 0.042-0.052 cases) per 100,000 population. Admission and fatality rates for drug- and insect sting–induced anaphylaxis were highest in the group aged 60 years and older. In contrast, admissions because of food-triggered anaphylaxis were most common in young people, with a marked peak in the incidence of fatal food reactions during the second and third decades of life. These findings are not explained by age-related differences in rates of hospitalization. Conclusions Hospitalizations for anaphylaxis increased between 1992 and 2012, but the incidence of fatal anaphylaxis did not. This might be due to increasing awareness of the diagnosis, shifting patterns of behavior in patients and health care providers, or both. The age distribution of fatal anaphylaxis varies significantly according to the nature of the eliciting agent, which suggests a specific vulnerability to severe outcomes from food-induced allergic reactions in the second and third decades.

Low preparedness for food allergy as perceived by school staff: a EuroPrevall survey across Europe Thuy-My Le, MD, PhD*, Ischa Kummeling, PhD*, Danielle Dixon, MD, Laura Barreales Tolosa, MD, Barbara Ballmer-Weber, MD, Michael Clausen, MD, M. Hazel Gowland, BA, Barbara Majkowska-Wojciechowska, MD, Tihomir Mustakov, MD, Nikolaos G. Papadopoulos, MD, PhD, Andre C. Knulst, MD, PhD, James Potts, BSc, Rimantas Stukas, PhD, and Peter Burney, MD

This article is made available through the Brunel Open Access Publishing Fund. Copyright @ 2013 Barnett et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Objective: Food labelling is an important tool that assists people with peanut and tree nut allergies to avoid allergens. Nonetheless, other strategies are also developed and used in food choice decision making. In this paper, we examined the strategies that nut allergic individuals deploy to make safe food choices in addition to a reliance on food labelling. Methods: Three qualitative methods: an accompanied shop, in-depth semi-structured interviews, and the product choice reasoning task – were used with 32 patients that had a clinical history of reactions to peanuts and/or tree nuts consistent with IgE-mediated food allergy. Thematic analysis was applied to the transcribed data. Results: Three main strategies were identified that informed the risk assessments and food choice practices of nut allergic individuals. These pertained to: (1) qualities of product such as the product category or the country of origin, (2) past experience of consuming a food product, and (3) sensory appreciation of risk. Risk reasoning and risk management behaviours were often contingent on the context and other physiological and socio-psychological needs which often competed with risk considerations. Conclusions: Understanding and taking into account the complexity of strategies and the influences of contextual factors will allow healthcare practitioners, allergy nutritionists, and caregivers to advise and educate patients more effectively in choosing foods safely. Governmental bodies and policy makers could also benefit from an understanding of these food choice strategies when risk management policies are designed and developed. United Kingdom Food Standards Agency

For individuals with a nut allergy, the avoidance of allergens is particularly challenging in situations where they are not preparing their own food. Many allergic reactions occur when eating outside the home.To identify and explore the challenges faced by nut-allergic individuals (NAIs) when they are eating in restaurants and other eating establishments.A qualitative interview study was conducted with 32 adults with a clinical history of allergy to peanuts and/or tree nuts.The main strategies that participants adopted to manage the risk of allergic reactions when eating outside the home were avoidance and communication. They avoided types of restaurants, meal courses or particular foods. Seeking familiarity was a key strategy that enabled NAIs to reduce uncertainty and anxiety. Language differences were a major barrier to confident communication about food content. The need to check whether the food on offer may contain nuts was a source of social embarrassment for many participants and the desire to avoid this sometimes led to increased risk taking. Some did not disclose their allergy to restaurant staff as they feared a conservative reaction that would further constrain food choices. NAIs often have to plan where to eat out. The consequent lack of spontaneity was a source of regret to some.Communication patterns of nut-allergic adults are often grounded in legitimate everyday social considerations around embarrassment, choice and spontaneity. Education and training strategies are needed that recognize and take account of this. Focusing on communication deficits of NAIs may be unhelpful; responsibility for food safety must be shared with the food industry.

We have reached a point where it is difficult to improve food allergy risk management without an agreement on levels of acceptable risk. This paper presents and discusses the perspectives of the different stakeholders (allergic consumers, health professionals, public authorities and the food industry) on acceptable risk in food allergy. Understanding where these perspectives diverge and even conflict may help develop an approach to define what is acceptable.Uncertainty about food allergy, its consequences and how to manage them is the common denominator of the stakeholders' views. In patients, uncertainty is caused by the unpredictability of reactions and the concern about whether avoidance strategies will be effective enough. Variability of symptoms and the lack of markers do not allow stratification of patients according to their reactivity, and force health professionals to give the same advice to all patients despite the fact that the risk to each is not identical. Regulators and the food industry struggle with the fact that the lack of management thresholds forces them to make case-by-case decisions in an area of uncertainty with penalties for under- or over-prediction. As zero risk is not a realistic possibility, consensus on acceptable risk will be needed. (C) 2010 Elsevier Inc. All rights reserved.

The profile of potentially fatal food allergies has altered in recent years. The vigilance required for allergen avoidance when shopping or eating out depends on information which is often hidden or misleading. Families with allergic children suffer social exclusion and stress, made worse by a serious shortage of specialist patient care. Those who die are usually teenagers and young adults who suffer from severe allergic asthma or anaphylaxis after eating away from the home. A recognised manufacturing standard would endorse businesses seeking to remove the risk of allergen cross-contamination, whilst the integration of allergy into training for caterers and environmental health professionals would influence and inform foodservice businesses.

Background Buying behaviours of food-allergic consumers can affect the risk they incur. An online survey was undertaken to understand the characteristics and buying behaviours of food-allergic consumers in Great Britain (GB) and people buying food for them. Methods Descriptive study of food-allergic individuals in GB and their buying behaviours, based on a survey of 500 food-allergic consumers and 500 people buying for allergic individuals. Results Fruit and vegetables were the most commonly mentioned food allergens for adults, cows’ milk in school-age children and eggs in younger children. 45% of respondents reported a formal diagnosis, almost half (48%) by a specialist. Significantly (P

Increasing numbers of consumers with food allergies encounter challenges when eating food from restaurants, cafeterias and fast food outlets, and also when choosing food sold without factory packaging. Trends have changed in recent decades. We prepare less food at home from ingredients, so that younger generations have fewer preparation skills and limited food knowledge. At the same time, we travel more widely, and enjoy experiencing dishes which originate around the world served by our local food businesses. Those diners who need to avoid particular foods to protect their health face a range of practical difficulties, starting with the need to find out exactly what dishes contain as ingredients, and then whether the food business has managed to prepare a particular item or dish without contamination from the allergen to be avoided, sometimes in trace quantities. Evidence from fatal reactions to foods and also reported by patient group members indicates that the most important factor in effective avoidance is access to the CORRECT information about what food contains. Most fatal reactions involve consumption of food containing the culprit allergen. In some cases, the allergic person was not actively avoiding the particular allergen, perhaps through lack of accurate diagnosis or avoidance advice, but even those with accurate diagnoses and well-honed avoidance skills have been caught out. Typical barriers include: not retaining the correct information, poor information-sharing between preparation and service staff, inconsistent recipes, menu words from other languages / cultures which are not understood by staff / customers, cross-contamination in preparation or service, including shared utensils on self-service buffets, customers being nervous about asking for information in front of their friends or colleagues, and not wanting to make a fuss. This presentation will present case files, practical risk assessment and some examples of effective solutions to protect food allergic consumers eating catered food.

Copyright @ 2011 Barnett et al.; licensee BioMed Central Ltd. This article is available through the Brunel University Open Access Publishing Fund. Background: Precautionary 'may contain' warnings are used to indicate possible allergen contamination. Neither food safety nor food labelling legislation address this issue. The aim of this study is to understand how peanut and nut allergic adults interpret 'may contain' labelling and how they use this information when purchasing food. Methods: Qualitative methods were used to explore both behaviour and attitudes. The behaviour and 'thinking aloud' of 32 participants were recorded during their normal food shop. A semi-structured interview also explored participants' views about 13 potentially problematic packaged foods. Transcribed data from these tasks were analysed to explore the interpretation of 'may contain' labelling and how this influenced food choice decisions. Results: Peanut and nut allergic individuals adopt a complex range of responses and strategies to interpret 'may contain' labelling. Many claimed such labelling was not credible or desirable; many ignored it whilst some found it helpful and avoided products with all such labelling. Interpretation and consequent decisions were not only based on the detail of the labelling but also on external factors such as the nature of the product, the perceived trustworthiness of the producer and on the previous experience of the nut allergic individual. Conclusions: 'May contain' labelling was interpreted in the light of judgements about the product, producer and previous personal experience. It is vital that these interpretation strategies are taken into account by those responsible for labelling itself and for the provision of advice to nut allergic individuals. Suggestions to improve labelling and advice to the allergic individual are considered. This study formed part of a wider research study to investigate the ways in which food allergic consumers make food purchasing and food consumption decisions, which was funded by the UK Food Standards Agency under project code T07058.